Evaluating Senior Housing: Applying the Least Restrictive Environment



In a perfect world, family members would always agree on the safest housing situation for a senior - whether that was their own home, a family member’s home, or a senior living community. The senior would agree with all of her children, and they would always agree with one another. There would be perfect harmony and everyone would be on the same page. Furthermore, this ideal housing would be within the family’s financial means, and of course, in the perfect location.


In reality, we find that consensus is hard to win, senior living and/or home care is expensive, and we often have to settle for less-than-ideal circumstances.


So, what can you do when there are disagreements about where a senior should live? Specifically, how do you tolerate risk when you’re concerned about safety? How do you deal with stubbornness, the high cost of care, or other factors?


The “least restrictive environment” is a concept that comes from the Individuals with Disabilities Education Act (IDEA). It states that all children should be allowed to learn in groups of their peers “to the maximum extent appropriate.” Separate services or classes are only allowed if learning “cannot be achieved satisfactorily” in the least restrictive environment. This principle is intended to protect the rights of children with disabilities.


Senior care professionals have borrowed the term to refer to a similar idea: that seniors should be allowed to live in their communities and maintain the highest level of independence possible. Generally, one’s home is less restrictive than assisted living, which is less restrictive than a memory care community. You get the picture. In parallel to its application with children, this principle guides decision-making that honors the self-determination and the rights of seniors.


Families often want seniors to move to a more structured environment because they have concerns about safety at home. These are reasonable and valid concerns, and a more structured environment may be the right place for your loved one. However, the unfortunate truth is that accidents, falls, infections, and injuries happen everywhere including hospitals, skilled nursing facilities, and assisted living communities.



Most of the time, people maintain the right to make decisions for themselves even if their families disagree with them. You can try to exercise your excellent skills of persuasion, but sometimes the best negotiator stills end up at a stalemate.


Here are some tips to minimize risk and maximize safety in the home:

  1. Request an in-home occupational therapy evaluation, purchase the recommended safety equipment, and use the equipment!

  2. Reduce the risk of trips and falls by encouraging exercise and removing items that can cause trips (like area rugs)

  3. Engage quality caregivers early on, before a crisis

A geriatric care manager can help you assess your housing options, choose a home care agency, and get an occupational therapy evaluation. Most importantly, a geriatric care manager can help you navigate the challenging waters of senior housing and make unique recommendations for a short-term and long-term plan that makes sense for you and your family.

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